Healthcare Provider Details

I. General information

NPI: 1003989419
Provider Name (Legal Business Name): MICHAEL D KRAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY STE 280
VISTA CA
92083-6034
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-3630
  • Fax: 760-941-1214
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG41229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: